AB1593 SEVERE IMPACT OF THE ECONOMIC CRISIS ON TREATMENT PERSISTENCE IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES: A MULTICENTRIC CROSS-SECTIONAL STUDY IN LEBANON
Authors: S. Asmar, J. Messaykeh, N. Hilal, M. A. Rida, K. Mroue’, K. Aouad, F. Minkara, A. Hajjar, N. Ziade
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Due to Lebanon's unprecedented economic crisis, access to healthcare and chronic treatments is compromised, which might affect chronic disease control. <h3>Objectives</h3> The primary objective of this study was to evaluate the impact of the economic crisis on chronic treatment persistence in patients with rheumatic and musculoskeletal diseases (RMDs) in Lebanon and to estimate the predictors of persistence. <h3>Methods</h3> A cross-sectional multicentric national study was conducted between July and October 2022 on patients with RMDs living across Lebanon (patients with chronic inflammatory rheumatic diseases (CIRDs) and controls with non-inflammatory RMDs). A questionnaire hosted on the Google Forms platform was proposed to consecutive patients during the consultation and disseminated on social media and WhatsApp lists. It included sociodemographic, disease, and treatment data, income, PHQ-9, and GAD-7 questionnaires. Treatments were categorized into corticosteroids, NSAIDs, cs-DMARDs, b-DMARDs (IV and SC), ts-DMARDs, and oral immunosuppressants. Persistence was defined quantitatively as the number of tablets or injections taken during the past month compared to prescribed and qualitatively as the percentage of patients who changed or discontinued chronic RMD treatment due to cost or nonavailability. Data were presented descriptively; factors associated with persistence were identified using multivariable linear regression. <h3>Results</h3> In total, 317 patients with RMDs (286 CIRDs and 31 controls) were included (207 by telephone interview and 110 by self-questionnaires); mean age 49.5 years (SD 16), 68% females, median disease duration 10 years (IQR 6-20), 58% had moderate to severe depression, and 40% had moderate to severe anxiety. Persistence was low for b-DMARDs (SC 55%, IV 63%) and ts-DMARDs (36%) and acceptable for oral immunosuppressants 85.3% and cs-DMARDs (88%) (Figure 1). Among patients with CIRDs, 55.8% discontinued or changed their chronic medication due to nonavailability (45.3%) or increased cost (21.2%). Discontinuation or change affected mainly SC b-DMARDs (66.2%), ts-DMARDs (60.0%), and IV b-DMARDs (40.0%). Notably, patients reported a decrease in their financial level in 86% of the cases, and 58% reported they were currently living in a low economic level (compared to only 6% before the crisis). Compared to controls, patients with CIRDs had a reduction in the number of visits to the doctor, more difficulty accessing chronic treatments (91% vs. 33%), and paraclinical exams (84% vs. 77%). They expressed a higher need for financial support for medication, paraclinical tests, and medical consultation. Importantly, patients could find an alternative source for getting their medication in 60% of cases (buying from abroad in 36%, depending on friends or families living abroad in 20%, and charities in 10%). Finding an alternative source for medication was independently associated with a higher persistence of cs-DMARDs, b-DMARDs, and ts-DMARDs. In addition, being unemployed and having a low financial level were associated with a low persistence of cs-DMARDs and oral immunosuppressants. <h3>Conclusion</h3> Chronic treatment persistence was significantly compromised for essential drugs for patients with RMDs and was rather associated with extrinsic causes related to treatment availability and cost than with classically known intrinsic factors. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.